Estudio transversal retrospectivo de la evolución del consumo de opioides farmacológicos y de heroína en un grupo poblacional del área de Barcelona / Retrospective cross-sectional study of the evolution of the use of pharmacological opioids and heroin in a population group in the Barcelona area

Antecedentes: La dependencia de opioides está causando una epidemia en Estados Unidos, pero, a diferencia de la de los años setenta, parece más relacionada con los opioides de prescripción que con la heroína.ObjetivosEl objetivo de este estudio es evaluar si esta nueva epidemia ha llegado ya a nuestro medio y ver si hay cambios en el consumo y en las características de los consumidores.Pacientes y métodosEstudio transversal retrospectivo. Se incluyeron 1.140 pacientes entre el periodo 2012 y 2019, 633 de los cuales fueron primeras visitas a Centros de Atención y Seguimiento a las drogadicciones (CAS), 502 corresponden a visitas en urgencias por problemas relacionados con sobredosis o abstinencia de heroína o de opioides con receta, y los 5 restantes son recién nacidos de madres adictas a la heroína. Se analizaron los datos demográficos y las características de las sustancias de abuso, comparándose entre períodos parciales.ResultadosSe produjo una disminución global de las primeras visitas de pacientes a los CAS que referían adicción a la heroína (p=0,001), mientras que los adictos a los opioides de farmacia se han mantenido estables. Ha habido un aumento irregular del total de urgencias, consultas por sobredosis y por abstinencia, tanto de heroína como de opioides con receta (p=0,062, p=0,166 y p=0,005, respectivamente). Las urgencias relacionadas con opioides han sido menos frecuentes que las relacionadas con heroína. Los pacientes europeos no españoles han aumentado respecto los españoles.ConclusiónNo se ha producido un aumento preocupante del abuso de heroína ni de opioides con receta en nuestro medio. (AU)

Background: Opioid dependence is causing an epidemic in the US, but unlike the 1970s it seems more related to prescription opioids than heroin.ObjectivesThe objective of this study is to assess whether this new epidemic has already reached our environment and to see if there are changes in consumption and in the characteristics of consumers.Patients and methodsRetrospective cross-sectional study. 1,140 patients were included between 2012 and 2019, 633 of whom were first visits to Drug Addiction Care and (CAS) Monitoring Centers, 502 corresponding to emergency room visits for problems related to overdose or withdrawal of heroin or opioids with prescription, and the remaining 5 are newborns of mothers addicted to heroin. Demographic data and characteristics of the substances of abuse were analyzed, comparing between partial periods.ResultsThere was a global decrease in the first visits of patients to the CAS who reported heroin addiction (P=.001), while those addicted to pharmacy opioids have remained stable. There has been an irregular increase in total emergency visits, overdose consultations, and withdrawal consultations, both for heroin and prescription opioids (P=.062, P=.166 and P=.005, respectively). Opioid-related emergencies have been less frequent than for heroin. Non-Spanish European patients have increased compared to Spanish patients.ConclusionThere has been no worrying increase in heroin or prescription opioid abuse in our setting. (AU)

[Retrospective cross-sectional study of the evolution of the use of pharmacological opioids and heroin in a population group in the Barcelona area]. / Estudio transversal retrospectivo de la evolución del consumo de opioides farmacológicos y de heroína en un grupo poblacional del área de Barcelona.

BACKGROUND: Opioid dependence is causing an epidemic in the US, but unlike the 1970s it seems more related to prescription opioids than heroin. OBJECTIVES: The objective of this study is to assess whether this new epidemic has already reached our environment and to see if there are changes in consumption and in the characteristics of consumers. PATIENTS AND METHODS: Retrospective cross-sectional study. 1,140 patients were included between 2012 and 2019, 633 of whom were first visits to Drug Addiction Care and (CAS) Monitoring Centers, 502 corresponding to emergency room visits for problems related to overdose or withdrawal of heroin or opioids with prescription, and the remaining 5 are newborns of mothers addicted to heroin. Demographic data and characteristics of the substances of abuse were analyzed, comparing between partial periods. RESULTS: There was a global decrease in the first visits of patients to the CAS who reported heroin addiction (P=.001), while those addicted to pharmacy opioids have remained stable. There has been an irregular increase in total emergency visits, overdose consultations, and withdrawal consultations, both for heroin and prescription opioids (P=.062, P=.166 and P=.005, respectively). Opioid-related emergencies have been less frequent than for heroin. Non-Spanish European patients have increased compared to Spanish patients. CONCLUSION: There has been no worrying increase in heroin or prescription opioid abuse in our setting.

Osificación heterotópica en COVID-19, ¿la asociación aún no documentada? Reporte de dos casos / Heterotopic Ossification in COVID-19: An Association Not Yet Documented? Two-case report

Se define como osificación heterotópica a la formación de tejido óseo en zonas de tejido blando en donde habitualmente no hay hueso. Se trata de una patología rara/ subdiagnosticada habitualmente relacionada con parálisis e inmovilización durante el curso crítico de traumatismos, lesiones neurológicas, síndrome de dificultad respiratoria aguda, cirugías o grandes quemados. En el transcurso de la pandemia por SARS-CoV-2 (nuevo COVID-19), se reportaron casos de pacientes críticos con osificación heterotópica y se interpretó que la magnitud de la reacción inflamatoria, posible efecto propio del virus, y los largos períodos de inmovilización mientras transcurría la etapa crítica podrían ser los determinantes de esta entidad clínica. Durante el período de internación de los casos que describiremos a continuación, el porcentaje ocupacional fue del 166 % y del 200 % y la carga laboral del personal de enfermería, medida por TISS-28, fue de 72 puntos, lo que excedió casi al doble de las posibilidades laborales. Al mismo tiempo, la rehabilitación motora, por parte del equipo de kinesiología, se vio postergada ante la necesidad de atender circunstancias urgentes como la optimización del soporte ventilatorio y la participación en maniobras de cambios de decúbito. De este modo, interpretamos que la gran sobrecarga laboral acontecida durante la pandemia condicionó una inadecuada provisión de movilización temprana que dio como resultado una mayor prevalencia de osificación heterotópica en pacientes pos-COVID grave cuando se la compara con síndrome de dificultad respiratoria aguda por otras causas. Presentamos dos casos de osificación heterotópica en pacientes que cursaron síndrome de dificultad respiratoria aguda por SARS-CoV-2 en momentos de alta carga laboral. Caso 1: Paciente masculino de 48 años, que ingresó a la UCI por NAC grave por COVID-19. Antecedentes de obesidad. Requirió 31 días de AVM, 4 ciclos de posición prona (192 h total), TQT al día 18, 23 días de bloqueantes neuromusculares y 24 de sedación. Comienza la movilización activa-asistida al día 24 con MRC 38/60. Un total de 52 días de internación. A los 6 meses del alta, se diagnosticó osificación heterotópica bilateral de cadera. Caso 2: Paciente de 58 años, que ingresa a UCI por NAC grave por COVID-19. Ante cedentes de HTA y obesidad. Requirió 39 días de AVM, dos ciclos de posición prona (60 h total), TQT al día 7. Un total de 45 días de UCI y 111 de hospital. Al año del alta, se diagnostica osificación heterotópica bilateral de cadera.

Heterotopic ossification (OH) is defined as the formation of bone tissue in areas of soft tissue where there is usually no bone. It is a rare/underdiagnosed pathology usually related to paralysis and immobilization during the critical course of trauma, neurological lesions, acute respiratory distress syndrome (ARDS), surgery, or major burns. In the course of the SARS-CoV2 (new COVID-19) pandemic, cases of critically ill patients with OH were reported, interpreting that the magnitude of the inflammatory reaction, possible effect of the virus itself, and long periods of immobilization while the critical stage was taking place could be the determinants of this clinical entity. During the hospitalization period of the cases that we will describe below, the occupa tional percentage was 166 % and 200 % and the workload of the nursing staff, mea sured by TISS-28, was 72 points, exceeding almost twice the possibilities labor. At the same time, motor rehabilitation by the Physiotherapy team was postponed due to the need to address urgent circumstances such as optimization of ventilatory support and participation in decubitus change maneuvers. In this way, we interpret that the great work overload that occurred during the pandemic conditioned an inadequate provision of early mobilization, resulting in a higher prevalence of OH in severe post-COVID patients when compared with ARDS due to other causes. We present two cases of HO in patients who underwent ARDS due to SARS-CoV2 at times of high workload. Case 1: A 48-year-old man, who was admitted to the ICU due to severe Pneumonia (NAC) due to COVID-19. History of obesity. He required 31 days of Mechanical Ven tilation Assistance (AVM), 4 cycles of prone position (192 total hours), tracheostomy (TQT) on day 18, 23 days of neuromuscular blockers and 24 of sedation. Active-assisted mobilization begins on day 24 with a Medical Research Council (MRC) score of 38/60. A total of 52 days of hospitalization. Six months after discharge, bilateral HO of the hip was diagnosed. Case 2: 58-year-old patient, admitted to the ICU with severe NAC due to COVID-19. History of Hypertension and Obesity. She required 39 days of AVM, two cycles of prone position (60 total hours), TQT on day 7. A total of 45 days in the ICU and 111 in the hospital. A year after discharge, bilateral OH of the hip was diagnosed.

Relación entre la cuenta de Twitter @ascolcirugia y las publicaciones de la Revista Colombiana de Cirugía durante la pandemia / Relationship between the Twitter account @ascolcirugia and the publications of the Colombian Journal of Surgery during the pandemic

Introducción. Indicadores alternativos basados en la web 2.0 han tomado importancia para medir el impacto de la producción científica. Previamente se han demostrado correlaciones positivas entre indicadores tradicionales y alternativos. El objetivo de este trabajo fue evaluar la relación de estos indicadores en el campo de la cirugía de nuestro país.Métodos. Análisis retrospectivo de las publicaciones de la Revista Colombiana de Cirugía y "tweets" de la cuenta @ascolcirugia entre marzo 2020 y julio 2021. Se evaluaron comparativamente los artículos con y sin publicación en la cuenta @ascolcirugia. Se determinó la correlación entre indicadores alternativos e indicadores tradicionales de las publicaciones de la revista. Resultados. En total se revisaron 149 artículos y 780 "tweets"; tan sólo el 13,4 % (n=20) de los artículos tuvieron visibilidad en la cuenta @ascolcirugia, con una mediana de 2 "tweets" (RIQ 1-2) por artículo, siendo la mayoría de estos sobre temas de COVID-19 (85 % vs 10 %; p<0,001). Los artículos publicados en @ascolcirugia tuvieron una mayor mediana de descargas (220 vs 116; p<0,001) y citaciones (3,5 vs 0; p<0,001) en comparación con los que no fueron publicados.Conclusión. El uso de las redes sociales tiene un efecto positivo en el número de lectores de la Revista Colombiana de Cirugía y el impacto académico de los autores. Aunque existe una buena correlación entre indicadores alternativos y tradicionales en el contexto nacional, la proporción de artículos de la Revista Colombiana de Cirugía publicados en la cuenta @ascolcirugia es baja.

Introduction. Alternative indicators based on web 2.0 have gained great relevance to measure the impact of scientific production. Positive correlations between traditional and alternative indicators have previously been shown. The objective of our article is to evaluate the relationship of these indicators in the field of surgery in our country.Methods. Retrospective analysis of the publications of the Colombian Journal of Surgery and tweets of the Twitter account (@ascolcirugia) during March 2020 and July 2021. Articles with and without tweets in the account @ascolcirugia were comparatively evaluated. The correlation between alternative indicators and traditional indicators of the journal's publications was determined. Results. A total of 149 articles and 780 tweets were reviewed; only 13.4% (n=20) of the articles had visibility at the @ascolcirugia account, with a median of 2 tweets (RIQ 1-2) per article, most of which were on COVID-19 issues (85% vs 10%; p<0.001). The articles published at the @ascolcirugia account had a higher median number of downloads (220 vs 116; p<0.001) and citations (3.5 vs 0; p<0.001) compared to the articles that were not published. Conclusions. The use of social media has a positive effect on the number of readers of the Colombian Journal of Surgery and the academic impact of the authors. Although there is a good correlation between alternative and traditional indicators, in the national context, the proportion of articles of the Colombian Journal of Surgery published at the @ascolcirugia account is low

Helical 6-Strand Cruciate Tenorrhaphy: Description of a New Technique and Biomechanical Comparative Analysis With 2 Standard Techniques.

Background: Multiple flexor tendon repair techniques have been developed over the last years. Despite all this, there is no standard technique that has proven to be superior to others, leading to great variability in the use of techniques in surgical practice. We describe a novel tendon repair technique and compare its biomechanical characteristics with 2 conventional techniques. Methods: Comparative experimental biomechanical study in ex vivo animal models. In all, 66 deep flexor tendons of the pig's front legs were taken and it's repair was performed by 1 of 3 techniques (helical 6-strand cruciate tendon repair, Adelaide tendon repair, or modified Kessler). These repairs were subjected to biomechanical study, measuring, and registering the ultimate tensile strength, load to 2-mm gap force, and stiffness. Results: The helical 6-strand cruciate tenorrhaphy compared with the Adelaide and modified Kessler techniques carries statistically significant greater ultimate tensile strength before failure (65.5, 46, and 36 N, respectively, P < .001). It also required a greater load to 2-mm gap force and is less stiff, allowing greater strain before failure. This technique does not generate significant changes in the dimensions of the tendons compared to the others, and there was no significant difference in the strength of repair between surgeons. Conclusions: The helical 6-strand cruciate tenorrhaphy is a novel technique, useful for the repair of flexor tendons in the hand that holds up the necessary forces to initiate early mobilization in the postoperative period and has better biomechanical properties than 2 standard techniques.

Presence of mycotic microorganisms in raw milk from cooling tanks in the Boyacense highlands (Colombia) / Presencia de microorganismos micóticos en leche cruda de tanques de enfriamiento en el Altiplano Boyacense (Colombia) / Presença de microrganismos micóticos no leite cru de tanques de resfriamento no Altiplano Boyacense (Colômbia)

Abstract Yeasts and molds are germs that should not be found in milk samples because they are potentially pathogenic for both animals and humans. Due to its high handling during collection, storage, and transport, milk is susceptible to contamination with these microorganisms, so its detection in this food in these phases is relevant in order to prevent possible situations that compromise public health. The objective of the present work was to determine the presence of molds and yeasts in samples of milk cooling tanks in the Boyacense highlands. Samples were taken from 20 raw milk cooling tanks located in 20 different dairy municipalities of the department of Boyacá in order to determine the presence of molds and yeasts through Compact Dry YM®. 35% of the samples of milk did not present growth of molds or yeasts, meanwhile, in 25% yellow colony growth and its tonalities were found, which would correspond with mold colonies, in 5% determined the growth only of blue colonies, corresponding to yeast growth. In the remaining 35% growth of blue and yellow colonies was detailed. This shows that there is a high percentage of molds and yeasts in samples of refrigerated raw milk, a situation that could trigger a public health problem.

Resumen Las levaduras y los mohos son gérmenes que no se deben encontrar en muestras de leche porque son potencialmente patógenos tanto para los animales como para el ser humano. Debido a su alta manipulación durante la recolección, almacenamiento y transporte, la leche es susceptible de contaminación con estos microorganismos, por lo cual su detección en este alimento en estas fases, es relevante con el fin de prevenir posibles situaciones que comprometan la salud pública. El objetivo del presente trabajo fue determinar la presencia de mohos y levaduras en muestras de tanques de enfriamiento de leche en el Altiplano Boyacense. Se tomaron muestras de 20 tanques de enfriamiento de leche cruda ubicados en 20 diferentes municipios lecheros del departamento de Boyacá con el fin de determinar la presencia de mohos y levaduras a través de Compact Dry YM®. El 35% de las muestras de leche no presentó crecimiento de mohos ni de levaduras, por su parte, en el 25% se encontró crecimiento de colonias de color amarillo y sus tonalidades, lo que correspondería con colonias de mohos, en el 5% se determinó el crecimiento únicamente de colonias azules, correspondiente a crecimiento de levaduras. En el 35% restante se detalló un crecimiento de colonias azules y amarillas. Esto demuestra que existe un alto porcentaje mohos y levaduras en muestras de leche cruda refrigerada, situación que podría desencadenar un problema de salud pública.

Resumo Leveduras e fungos são germes que não devem ser encontrados em amostras de leite, pois são potencialmente patogênicos tanto para animais como para humanos. Devido ao seu alto manuseio durante a coleta, armazenamento e transporte, o leite é suscetível à contaminação com esses microrganismos, por isso sua detecção neste alimento nestas fases, é relevante para prevenir possíveis situações que comprometam a saúde pública. O objetivo do presente trabalho foi determinar a presença de bolores e leveduras em amostras de tanques de resfriamento de leite no Altiplano de Boyacense. Foram coletadas amostras de 20 tanques de resfriamento de leite cru, localizados em 20 diferentes municípios leiteiros do departamento de Boyacá, a fim de determinar a presença de bolores e leveduras através do Compact Dry YM®. 35% das amostras de leite não apresentaram crescimento de bolores ou leveduras, entretanto, em 25% de crescimento de colônia amarela e suas tonalidades foram encontradas, o que corresponderia às colônias de bolores, em 5% determinou o crescimento apenas das colônias azuis, correspondendo ao crescimento das leveduras. Isso mostra que há uma alta porcentagem de bolores e leveduras em amostras de leite cru refrigerado, situação que pode desencadear um problema de saúde pública.

Exploring karyotype diversity of Argentinian Guaraní maize landraces: Relationship among South American maize.

In Argentina there are two different centers of maize diversity, the Northeastern (NEA) and the Northwestern (NWA) regions of the country. In NEA, morphological studies identified 15 landraces cultivated by the Guaraní communities in Misiones Province. In the present study we analyzed the karyotype diversity of 20 populations of Guaraní maize landraces through classical and molecular cytogenetic analyses. Our results demonstrate significant intra and inter-populational variation in the percentage, number, size, chromosome position and frequencies of the heterochromatic blocks, which are called knobs. Knob sequence analysis (180-bp and TR-1) did not show significant differences among Guaraní populations. B chromosomes were not detected, and abnormal 10 (AB10) chromosomes were found with low frequency (0.1≥f ≤0.40) in six populations. Our results allowed karyotypic characterization of each analyzed population, defining for the first time the chromosomal constitution of maize germplasm from NEA. The multivariate analysis (PCoA and UPGMA) of karyotype parameters allowed the distinction between two populations groups: the Popcorn and the Floury maize populations. These results are in agreement with previously published microsatellite and morphological/phenological studies. Finally, we compared our karyotype results with those previously reported for NWA and Central Region of South America maize. Our data suggest that there are important differences between maize from NEA and NWA at the karyotype level, supporting the hypothesis that there are two pathways of input of South America maize. Our results also confirm the existence of two centers of diversification of Argentinian native maize, NWA and NEA. This work contributes new knowledge about maize diversity, which is relevant for future plans to improve commercial maize, and for conservation of agrobiodiversity.

Safety and efficacy of the endoscopic duodenal-jejunal bypass liner prototype in severe or morbidly obese subjects implanted for up to 3 years.

BACKGROUND: The duodenal-jejunal bypass liner (DJBL) is an endoscopic device that mimics the duodenal-jejunal exclusion component of the Roux-en-Y gastric bypass. Previous studies assessing the efficacy of the DJBL have shown 10-40% excess weight loss (%EWL) and improvements in obesity-associated comorbidities. The aim of this study was to evaluate the safety and efficacy of a new DJBL prototype over a 3-year period. METHODS: Morbidly obese subjects were enrolled in a single-arm, open-label, prospective trial. The subjects were offered the opportunity to continue with the trial annually and signed a new consent form. The primary endpoint was safety. The secondary endpoints were changes in weight and biochemical parameters from baseline. RESULTS: The DJBL was implanted endoscopically in 80 subjects (age: 35±10 years; 69% female; weight: 109±17 kg; BMI: 42±5.4 kg/m2). Seventy-two severe adverse events (AEs) were observed in 55 patients (68%), of which nine subjects required a prolonged hospital stay and three subjects required major interventions. Overall, 23 subjects (29%) underwent early device removal due to AEs. Additionally, 95% of the patients experienced mild AEs that mainly consisted of abdominal pain. The severe AEs included a liver abscess (3), upper GI bleeding (4), cholangitis (1), and acute pancreatitis (1) and mostly occurred after 12 months of follow-up. Two patients presented a short esophageal perforation during explantation. These perforations were successfully managed with endoscopic closure in one subject and medical treatment in the other subject. In the completer population at 52 weeks (71 patients), 104 weeks (40 patients), and 156 weeks (11 patients), the mean %EWL were 44 ± 16, 40 ± 22, and 39 ± 20, respectively (p < 0.001). CONCLUSION: This study shows significant and sustained weight loss after 3 years of treatment with the new DJBL. However, the high frequency and severity of AEs preclude the use of this prototype for periods longer than 1 year.

El ejercicio físico disminuye la pérdida de masa magra en pacientes obesos sometidos a cirugía bariátrica / Exercise reduces lean mass loss in obese patients undergoing bariatric surgery

Objetivo: Caracterizar el efecto de un programa de ejercicio físico en la pérdida de masa magra en pacientes obesos mórbidos durante el primer año después de la cirugía bariátrica. Pacientes y métodos: Estudio de cohorte no concurrente de pacientes obesos mórbidos sometidos a bypass gástrico en Y de Roux (BPGYR) o gastrectomía en manga (GM) que contaran con medición de su composición corporal antes y a los 3, 6 y 12 meses después de la cirugía. Los pacientes se clasificaron como ejercicio físico (+) o ejercicio físico (−) según realizaran o no un programa de ejercicio físico supervisado durante el primer año después de la cirugía. Resultados: Se identificaron 35 pacientes obesos mórbidos sometidos a BPGYR o GM. Veinte (57%) pacientes fueron ejercicio físico (+) y 15 (43%) ejercicio físico (−). Los promedios de edad e IMC preoperatorio en ejercicio físico (+) y ejercicio físico (−) fueron de 33,5 ± 8,9 y 43,3 ± 12,4 años (p < 0,05), y 40,4 ± 7,1 y 35,8 ± 5 kg/m² (p < 0,05), respectivamente. No hubo diferencias en composición corporal entre ambos grupos. Un año después de la cirugía, la pérdida de masa magra en pacientes ejercicio físico (+) y ejercicio físico (−) representó un 17,9 ± 4,1% y 30,1 ± 4,5% del total de la pérdida de peso, respectivamente (p < 0,05). Conclusiones: Estos resultados sugieren que la estimulación muscular mediante ejercicio físico regular logra disminuir la pérdida de masa magra observada después de la cirugía bariátrica, mejorando así la composición corporal de los pacientes.

Objective: We sought to characterize the effect of a physical exercise program on fat free mass loss in morbidly-obese patients one year after bariatric surgery. Patients and methods: Retrospective cohort study of a group of patients who underwent Roux-en-Y gastric bypass (RYGB) or Sleeve Gastrectomy (SG) and had body composition analysis before and at 3, 6 and 12 months after surgery. Identified patients were further classified as physical exercise (+) or physical exercise (−) based on whether they followed or not a physical exercise program during the first year after surgery. Results: We identified 35 morbidly obese patients who underwent RYGB or SG. 20 (57%) patients were physical exercise (+) and 15 (43%) patients were physical exercise (−). Mean age and preoperative BMI in physical exercise (+) and physical exercise (−) patients was 33.5 ± 8.9 and 43.3 ± 12.4 years (P < .05), and 40.4 ± 7.1 and 35.8 ± 5 kg/m² (P < .05), respectively. There were no differences in body composition between both groups. One year after surgery, fat free mass loss in physical exercise (+) and physical exercise (−) patients represented 17.9 ± 4.1% and 30.1 ± 4.5% of total weight loss, respectively (P < .05). Conclusions: The results of this study suggest that muscle stimulation through physical exercise can decrease the lean body mass loss induced by surgery, thus improving body composition outcomes after surgery.

Dissecting maize diversity in lowland South America: genetic structure and geographic distribution models.

BACKGROUND: Maize landraces from South America have traditionally been assigned to two main categories: Andean and Tropical Lowland germplasm. However, the genetic structure and affiliations of the lowland gene pools have been difficult to assess due to limited sampling and the lack of comparative analysis. Here, we examined SSR and Adh2 sequence variation in a diverse sample of maize landraces from lowland middle South America, and performed a comprehensive integrative analysis of population structure and diversity including already published data of archaeological and extant specimens from the Americas. Geographic distribution models were used to explore the relationship between environmental factors and the observed genetic structure. RESULTS: Bayesian and multivariate analyses of population structure showed the existence of two previously overlooked lowland gene pools associated with Guaraní indigenous communities of middle South America. The singularity of this germplasm was also evidenced by the frequency distribution of microsatellite repeat motifs of the Adh2 locus and the distinct spatial pattern inferred from geographic distribution models. CONCLUSION: Our results challenge the prevailing view that lowland middle South America is just a contact zone between Andean and Tropical Lowland germplasm and highlight the occurrence of a unique, locally adapted gene pool. This information is relevant for the conservation and utilization of maize genetic resources, as well as for a better understanding of environment-genotype associations.

Laparoscopic sleeve gastrectomy conversion to Roux-en-Y gastric bypass: experience in 50 patients after 1 to 3 years of follow-up.

BACKGROUND: Sleeve gastrectomy (SG) is currently one of the most frequently performed bariatric interventions worldwide due to its simplicity and good weight loss results. Nevertheless, SG failure and complications are increasingly being observed as the number of procedures increases. OBJECTIVES: To report our results in converting SG to revisional laparoscopic Roux-en-Y gastric bypass (R-LRYGB). SETTING: University Hospital, Chile. METHODS: Retrospective analysis of our bariatric surgery database. Patients who underwent R-LRYGB after SG between June 2005 and April 2015 were identified. Demographic characteristics, anthropometrics, preoperative workup, and perioperative data were retrieved. Total weight loss (TWL), excess weight loss (EWL), and clinical progression over 3 years were registered. RESULTS: Fifty patients were identified, mean age 39±8.4 years, 42 (84%) women; median body mass index previous to R-LRYGB was 33.8 (31-36) kg/m2. Indications for revision were weight regain (n = 28, 56%), gastroesophageal reflux disease (n = 16, 32%), and gastric stenosis (n = 6, 12%). In weight-regain patients, mean follow-up at 3 years was 72.2% and median percentage of total weight loss at 12 and 36 months was 18.5 (12-24) and 19.3 (8-23), respectively; percentage of excess weight loss at 12 and 36 months was 60.7 (37-82) and 66.9 (26-90), respectively. Over 90% of gastroesophageal reflux disease patients resolved or improved symptoms. All patients with gastric stenosis resolved symptoms after conversion. There were no major complications. CONCLUSION: R-LRYGB is a feasible, effective, and well-tolerated alternative in selected patients with failed SG in which other therapies have been insufficient to either maintain weight loss or resolve complications. However, long-term follow-up is still needed.

Novel treatments for complications after bariatric surgery.

Bariatric surgery has been considered one of best treatments for obesity. As every surgical procedure-and any medical intervention, it is not exempt of complications, among which leaks, strictures, acute hemorrhages and fistulae highlight. Leaks are more common in the gastro-jejunal anastomosis (GJA) in the case of Roux-en-y Gastric Bypass (RYGB), while in Sleeve Gastrectomy (LSG) they locate in the stapler line. Stenosis can be seen in the gastro-jejunostomy in the RYGB and in the gastric tube in case of the LSG. For each of these complications, many innovative solutions have been developed, including new surgical devices. In spite of promising good results, evidence regarding utility and safeness of these technologies is still scarce. Self-expandable endoscopic stents have been used to treat leaks, with an overall success rate of 80-90 % and a migration rate of 15-35 %. The bear trap-like over-the-scope (Ovesco) clips have been used to treat GI hemorrhages, leaks and even fistulae, with a 70-80 % success rate, although more endoscopic sessions may be needed. Overstitch, an endosurgical suture devices, have been used to treat leaks, fistulae and perforations. Overall, technical success achievement approaches to 90 %, while clinical success ranges from 80 to 90 %, except for leaks closure, where a lower success rate has been observed. Despite of all of these advances, early diagnosis and treatment remains the main strategy to achieve success. In summary, novel therapies for complication management can be very useful, though further studies with larger series are still needed in order to confirm their efficacy and safeness.

Intra-specific variation in genome size in maize: cytological and phenotypic correlates.

Genome size variation accompanies the diversification and evolution of many plant species. Relationships between DNA amount and phenotypic and cytological characteristics form the basis of most hypotheses that ascribe a biological role to genome size. The goal of the present research was to investigate the intra-specific variation in the DNA content in maize populations from Northeastern Argentina and further explore the relationship between genome size and the phenotypic traits seed weight and length of the vegetative cycle. Moreover, cytological parameters such as the percentage of heterochromatin as well as the number, position and sequence composition of knobs were analysed and their relationships with 2C DNA values were explored. The populations analysed presented significant differences in 2C DNA amount, from 4.62 to 6.29 pg, representing 36.15 % of the inter-populational variation. Moreover, intra-populational genome size variation was found, varying from 1.08 to 1.63-fold. The variation in the percentage of knob heterochromatin as well as in the number, chromosome position and sequence composition of the knobs was detected among and within the populations. Although a positive relationship between genome size and the percentage of heterochromatin was observed, a significant correlation was not found. This confirms that other non-coding repetitive DNA sequences are contributing to the genome size variation. A positive relationship between DNA amount and the seed weight has been reported in a large number of species, this relationship was not found in the populations studied here. The length of the vegetative cycle showed a positive correlation with the percentage of heterochromatin. This result allowed attributing an adaptive effect to heterochromatin since the length of this cycle would be optimized via selection for an appropriate percentage of heterochromatin.

The effects of intrauterine malnutrition on birth and fertility outcomes: evidence from the 1974 Bangladesh famine.

This article uses the Bangladesh famine of 1974 as a natural experiment to estimate the impact of intrauterine malnutrition on sex of the child and infant mortality. In addition, we estimate the impact of malnutrition on post-famine pregnancy outcomes. Using the 1996 Matlab Health and Socioeconomic Survey (MHSS), we find that women who were pregnant during the famine were less likely to have male children. Moreover, children who were in utero during the most severe period of the Bangladesh famine were 32 % more likely to die within one month of birth compared with their siblings who were not in utero during the famine. Finally, we estimate the impacts of the famine on subsequent pregnancy outcomes. Controlling for pre-famine fertility, we find that women who were pregnant during the famine experienced a higher number of stillbirths in the post-famine years. This increase appears to be driven by an excess number of male stillbirths.

Prevalence of BRCA1 and BRCA2 mutations in unselected breast cancer patients from medellín, Colombia.

BACKGROUND: Approximately 5% of all breast cancers can be attributed to a mutation in the BRCA1 or BRCA2 gene. The genetic component of breast cancer in Colombia has been, for the most part, studied on cases from the Bogota region. Five different founder mutations were in two studies of breast cancer patients in the Bogota region. It is important that the frequency of mutations be established among unselected cases of breast cancer of other regions of Colombia in order to estimate the genetic burden of this cancer in Colombia and to plan genetic services. The aim of this study was to establish the mutation frequencies of the BRCA genes in breast cancer patients unselected for family history or age, from Medellin, Colombia. METHODS: We enrolled 280 unselected women with breast cancer from a large public hospital in Medellin, Colombia. A detailed family history from each patient and a blood sample was obtained and processed for DNA analysis. Mutations in BRCA1 and BRCA2 were sought using a combination of techniques including a panel of recurrent Hispanic BRCA mutations which consists of fifty BRCA1 mutations and forty-six BRCA2 mutations, including the five recurrent Colombian BRCA mutations. All mutations were confirmed by direct sequencing. RESULTS: Genetic testing was successfully completed for 244 of the 280 cases (87%). Among the 244 cases, three deleterious mutations were identified (two in BRCA1 and one in BRCA2) representing 1.2% of the total. The average age of breast cancer in the mutation-positive cases was 34 years. The two BRCA1 mutations were known founder mutations (3450del4 in exon 11 and A1708E in exon 18). The BRCA2 mutation was in exon 11 (5844del5) and has not been previously reported in individuals of Colombian descent. Among the three mutation-positive families was a breast cancer family and two families with no history of breast or ovarian cancer. CONCLUSION: The frequency of BRCA mutations in unselected breast cancer cases from the Medellin region of Colombia is low and is approximately 1.2%.

Perfil epidemiológico del servicio de urgencias según motivo de consulta. Hospital de San José Bogotá DC, Septiembre 2011 a Febrero 2012 / Epidemiological profile of the emergency department according to reasons for consultation. Hospital de San José Bogotá DC - September 2011 to February 2012

El servicio de urgencias del Hospital de San José de Bogotá DC adelanta la implementación de un programa de registros clínicos con fines estadísticos y propósitos de investigación. Objetivo: establecer el perfil epidemiológico del servicio de urgencias de adultos con base en la información del software e-salud en un período de seis meses. Métodos: se obtuvieron 18.519 registros de septiembre 2011 a febrero 2012. Las variables consideradas fueron edad, género, responsable del pago de la atención, clasificación triage, tiempo de espera para la atención y motivo de consulta; los datos fueron procesados con frecuencias, medidas de tendencia central y dispersión en Stata 10. Resultados: la población atendida en su mayoría fue menor de 50 años (65%), 52.6% fueron hombres, la edad promedio 43 años, el principal pagador corresponde a la aseguradora (EPS 90.3%), los motivos de consulta más frecuentes fueron dolor abdominal (61.2%), trauma (14.2%) y cefalea (10,2%). El tiempo de espera para la atención fue menor de quince minutos en el 85% de los casos. Conclusión: no existieron diferencias entre el perfil epidemiológico obtenido con la información arrojada por el sistema de registro e-Salud y el previo del personal de facturación. Los hallazgos sugieren ajustar y ampliar las guías trazadoras del servicio...

The emergency department at Hospital de San José, Bogotá DC is currently implementing a clinical information recording system for statistical and research purposes. Objective: to establish the adult ER epidemiological profile based on data obtained with the e-Salud software during a six-month period. Methods: we obtained 18,519 records between September 2011 and February 2012. Variables analyzed included: age, gender, payer of healthcare services, triage classification, wait time and reason for consultation; Stata 10 was utilized for data analysis using frequencies and central and dispersion tendency measures. Results: patients seen were mostly under age 50 (65%), 52.6% were males, average age was 43 years, the main payer was patient´s insurance company (EPS 90.3%), the main reasons for consultation were abdominal pain (61.2%), trauma (14.2%) and headache (10.2%). Wait time was less than 15 minutes in 85% of cases. Conclusion: no differences were found between the epidemiological profile obtained with the e-Salud software and the information garnered from the ER invoicing staff. Findings suggest that ER care tracking guidelines must be adjusted and enlarged...

Isquemia de ganglios basales por intoxicación de heroína y cocaína aspiradas / Basal ganglia ischemia by aspirated heroin and cocaine intoxication

La cocaína es una de las drogas de abuso más usadas en el mundo y se relaciona con la aparición de eventos isquémicos y hemorrágicos en el sistema nervioso central y cardiovascular. Esto se debe a diversos factores tales como: vasoespasmo, vasculitis cerebral, incremento de la agregación plaquetaria, cardioembolismo y urgencias hipertensivas asociadas con la alteración de la autorregulación cerebral. Se describe el caso de un paciente que ingresa a la Clínica Universitaria Bolivariana con un cuadro de intoxicación aguda por cocaína y heroína aspiradas. Presentó infarto agudo de miocardio con elevación del segmento ST en las derivaciones V1, V2 y V3, aumento de troponinas, hipomagnesemia, hipercalemia, hipocalcemia, acidosis mixta, neumonía aspirativa, depresión del estado de conciencia con respiración superficial, cianosis y síndrome de abstinencia, que se manejó con haloperidol en unidad de Cuidados intensivos. Posteriormente, el paciente presentó un cuadro de extrapiramidalismo secundario a este tratamiento, por ello se inicia desmonte del haloperidol y se administra biperideno y bromocriptina sin remisión total de los síntomas. Finalmente, se evidenció, por resonancia magnética nuclear, isquemia de ganglios basales. El objetivo de este reporte es describir las manifestaciones clínicas presentadas por el paciente asociadas con el consumo atípico de estas dos drogas, así como hacer una aproximación al manejo terapéutico de esta patología.

Microsatellite typing of ancient maize: insights into the history of agriculture in southern South America.

Archaeological maize specimens from Andean sites of southern South America, dating from 400 to 1400 years before present, were tested for the presence of ancient DNA and three microsatellite loci were typed in the specimens that gave positive results. Genotypes were also obtained for 146 individuals corresponding to modern landraces currently cultivated in the same areas and for 21 plants from Argentinian lowland races. Sequence analysis of cloned ancient DNA products revealed a high incidence of substitutions appearing in only one clone, with transitions prevalent. In the archaeological specimens, there was no evidence of polymorphism at any one of the three microsatellite loci: each exhibited a single allelic variant, identical to the most frequent allele found in contemporary populations belonging to races Amarillo Chico, Amarillo Grande, Blanco and Altiplano. Affiliation between ancient specimens and a set of races from the Andean complex was further supported by assignment tests. The striking genetic uniformity displayed by the ancient specimens and their close relationship with the Andean complex suggest that the latter gene pool has predominated in the western regions of southern South America for at least the past 1400 years. The results support hypotheses suggesting that maize cultivation initially spread into South America via a highland route, rather than through the lowlands.

Caracterísiticas del habito de fumar en una población / m

Esta investigacióin se realizó en la Cooperativa de Producción Agropecuaria (CPA) "Alfredo Yabur" de Consolación del Sur entre 1987 y 1988. Se estudiaron las características del hábito de fumar mediante una encuesta confeccionada en correspondencia con los objetivos en la población adulta de dicha comunidad rural. Se describen diversas variables relacionadas con los no fumadores, exfumadores y fumadores actuales. Se encontró una taza de prevalencia general de 48,4 por ciento de fumadores, con predominio en el sexo masculino. se señala como factor relacionado con la adopción del hábito, la existencia de antecedentes de éste en los padres. El motivo más frecunte, determinado por los no fumadores , fue el relacionado con el gusto; y como causa de abandono, el determinado por la afectación de la salud. Los datos se expresan en tablas estadísticas para hacer más fácil su interpretación (AU)

Estudio comparativo de la atención médica entre el médico de la familia y un policlínico comunitario tradicional / Coparative study of medical care by community family doctor and traditional community polyclinics

Se realizó un estudio en el Municipio de Consolación del Sur, provincia de Pinar del Río acerca de la atención del médico y enfermera de la familia con respecto a estos mismos profesionales que laboran en un policlínico comunitario tradicional, sin este modelo de atención. Se comparan algunas variables entre las poblaciones atendidas por ambos modelos en relación con los conocimientos de educación sanitaria y el grado de satisfacción de las necesidades de salud. Los datos primarios se obtuvieron mediante encuestas; los elementos del universo se seleccionaron mediante un muestreo irrestricto aleatorio para datos cualitativos y se compararon entre las poblaciones por una prueba de proporciones para muestras grandes y pequeñas, según el caso. Se concluye que el modelo de atención del médico y enfermera de la familia es notoriamente superior en muchos aspectos que al de un policlínico comunitario tradicional